Cleft Lip/Cleft palate/Pyloric Stenosis Flashcards
Cleft Lip/Cleft Palate
-Congenital anomaly: results from incomplete fusion of embryonic structures surrounding oral cavity
-Globule b/w nose, gums, teeth (if these 3 doesn’t fuse, can end up with cleft palate)
-Most common faical deformity
>CL occurs in 1 in 600 births
>CP occurs in 1 in 2500 births
-Occurs either:
>Alone or in combination
>Bilateral or unilateral
Etiology: Multifactorial
-Genetics:
>increase in relatives, siblings
>Higher incidence in monozygotic twins vs dizygotic
>Chromosome syndromes
-Environment:
>Drugs (what mom did during pregnancy)
>Folic Acid deficiency (take folic acid during pregnancy = decrease chance of defect)
>Alcohol Ingestion
>Smoking
When does cleft develop during pregnancy?
Embryonic development of lip happens in weeks 5-8, that’s when mothers barely know they are prego
-Palate is weeks 7-12 when develop is complete
Cleft Lip
-extent varies: simple notch in vermillion line, involvement reaches nasal floor
-commonly involves abnormal development of:
>external nose
>Nasal septum
> Nasal cartilage
Cleft Palate
-occurs with cleft lip in 5-% cases (most of the time it is bilateral)
-Degree of CP defect vaires: depth, width, length
-Often results in dental problems:
>missin gteeth
>malpositioned teeth
**Kids with CP has speech problems
Manifestations and Diagnosis of CL/CP
-LIP: apparent at birth
>able to see on US (3D)
>can see at 14-16 weeks gestation
>Can anticipate this
-PALATE: requires inspection
>Gloved finger (put finger in mouth and palpate roof of mouth to make sure it's solid and look at oral cavity)
>Visualization of palate/oral cavity (soft mucous cleft is small and difficult to identify, tends to be cover by mucous membrane, little hole in palate, in NB: uvula can be split or look like a hanging down heart)
-Prenatal US
-Severe palate = Split uvulaTreatment for CL and CP
-Surgical Repair
-Multidisciplinary approach (pediatrician, plastic surgeons, orthodontist, speech therapist and nurse
-CL: typlically repaired at 1-3 months (book: 3-5 months) (can’t do before 1 month bc NB have problem handling secretions, anesthesia is a problem, have to be free of oral respiratory infection)
>Logan Bar/bow- help protect incision site
>+/- require revisions later in life
>usually minimal scarring
-CP: repaired at 12-18 months (problem with neonates is growth factor)
>Timing individualized r/t size/placement of defect
What is the goal for cleft palate
get palate together and to do it before they start talking bc we don’t want them to develop speech patter with cleft
Complications of CL/CP
- Generally some degree of speech impairment
- Some children more prone to OM = possible conductive hearing loss
- Orthodontic problems
- M,N,G- tongue is stopping pt from making these sounds
- Air escaping from roof of mouth = gives it hyper nasal quality to their speach
Feeding/Caregiver edu for CL/CP
-impaired sucking ability
>parents need lot of support and edu on feeding baby before discharge
>if can’t close = can’t latch on = interfere with sucking
-Various nipples and feeders
>Lambs nipple
>CP nurser
>Haberman feeder
>Breck feeder
>Syringe with red rubber catheter
-Position upright
-supervise feeding while in hospital
-teach s/s of aspiration and bulb syringe use
-Facial signal with feeding (raised eyebrows, wrinkle forehead: stop and let baby rest)
-Frequent burping
-Encourage bonding and atttachment
Why is nipple feeding important?
impt for muscle in mouth, which is impt with speech
- sucking is a satisfying thing for kids (give pacifier)
- breast feeding can be a problem bc of choking but still an option
What item is needed during feeding? why?
BULB SYRINGE: have this available everytime you feed bc they can easily aspirate and come out their nose, need to be ready to suck it out
Why? b/c they are nose breathers, got to keep nasal passage open
Why do we need to encourage bonding and attachment?
-parent may not feel comfortable with what to do and bonding may not exist
-don’t focus on what is wrong, focus on positive
>look how strong they are
>how much hair they have
>look at how well he is doing
-Reinforcement: helps them cope with what is going on
When feeding, what angle do you hold the baby?
45 degree
Prior to surgical repair: CL/CP
- gradual acquaintance to elbow restraints: usually soft, needed bc babies always rub their face
- Avoid prone position for CL: bc of pressure on surgical site, need to be supine
- infant/toddler must be free of infection: prone to OM or URE or aspiration
- Cheiloplasty: CL Repair
